Experts’ estimates of coverage needed for interventions to control HIV transmisson among injecting drug users

Allocating resources for the prevention of HIV infection among injecting drug users (IDUs) in transitional and developing countries can be a challenging task. The resources available are likely to be quite limited. But pilot programs are unlikely to have any meaningful effect on the transmission of HIV in IDU populations. There is also reason to believe that if prevention programming can reach a critical level in a local IDU population that very strong prevention effects can be achieved. The resource allocation question can be phrased in terms of 1) what interventions should be implemented? And 2) what level of “coverage” of the interventions should be achieved? We conducted a survey of 19 experts in HIV prevention to address these questions. There was strong agreement regarding which interventions are “very important,” with almost all respondents mentioning needle/syringe programs, outreach programs and drug abuse treatment (particularly opiate substitution treatment). There was modest agreement with respect to coverage, with a majority of the respondents giving a coverage of 20% to 33% of injections with new equipment obtained from needle/syringe programs and capacity to provide treatment for 20% to 33% of the local IDU population. Given cost factors, needle/syringe programs and outreach might be prioritized first in conditions of limited resources. While noting the need for local information and the multiple purposes of different programs, and the possibility that HIV prevalence and incidence rates might require higher coverage rates, we suggest that the agreement among these experts can be